The use of exercise testing has expanded greatly to help guide decisions about medical management and prognosis in a broad spectrum of patients. Numerous epidemiological studies in people with and without documented coronary artery disease have identified a low level of cardiorespiratory fitness as an independent risk factor for all-cause and cardiovascular mortality and that exercise capacity is inversely associated with healthcare costs. Accordingly, unfit men and women should be counselled to exercise in home-based or group preventative or rehabilitative programmes. In the era of managed care, the use of specialised exercise professionals for the supervision of exercise testing and training may represent a safe and cost-effective alternative to many hospitals, clinics and private physician practices. Clinical exercise physiologists (CEPs) can play a critical role in favourably modifying clients' level of cardiorespiratory fitness and physical activity habits. We detail the training of CEPs and outline the clinical settings where they have contributed substantially to healthcare delivery. We also outline the role of registered clinical exercise physiologists. It is important that exercise prescription is not left to a few individuals or small groups. It needs a concerted programme with all those in a position to make a difference actively contributing.

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Despite the passage of time, masters athletes are still capable of incredible performances. Nevertheless, overuse injuries are the most common challenge in this escalating cohort. The incidence of exertion-related cardiovascular events is also greater among older athletes, especially men, highlighting the importance of a thorough preparticipation medical evaluation before entry into senior athletic training programs and competition. Accordingly, masters athletes with a moderate to high risk for coronary artery disease, who desire to enter vigorous competitive events, should undergo peak or symptom-limited exercise testing. Training programs for senior athletes should be individually tailored and focus on the predominant energy pathways and performance requirements for a given sport. Although competition and "personal bests" are important, protection against sickness and disability are increasingly listed as the primary participative motives of older athletes.

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